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Opioid Addiction: An Open Letter to the 2016 Presidential Candidates

“…a disease needs to be transformed politically before it can be transformed scientifically.” –Siddhartha Mukherjee, The Emperor of All Maladies (A Biography of Cancer)

Ladies and Gentlemen,

As you are quickly discovering, the effects of opioid addiction on individuals, families, and communities will be a recurring issue in the 2016 Presidential campaign. Addiction to prescription opioids and heroin is increasing in the United States and leaving in its wake legions of overdose deaths, families struggling to find effective remedies, and local community leaders under pressure to forge a public response to these tragedies. As you campaign across the country, it will become clear that this epidemic is reaching into the most and least affluent and the most and least politically connected neighborhoods and families in this country. As you campaign from city to city, affected families, friends, fellow students, co-workers, and employers are going to ask you a pointed question: “What will you as President do to heal this bleeding wound within American communities?”

Historically, political candidates in such circumstances have pledged their commitment to tougher drug laws, intensified international and domestic drug enforcement, expansion of existing approaches to treatment, and expanding prevention resources. And yet these general approaches have neither prevented the rise of the current opioid addiction epidemic nor provided a sustainable framework for effective local responses to it. Leaving the prevention and broader drug supply policy issues aside for a moment, there are a number of science-grounded strategies that would offer support to the individuals and families caught in the net of this epidemic. Based on my experience working on the front lines of this problem for nearly half a century, here are twelve answers I suggest you include in your response to the “What will you do?” question.

Having reviewed the scientific research and talked with local leaders across the country, here is what I will do as your President to help those now affected by the opioid addiction epidemic.

I will help lead a national campaign to educate the public about addiction, addiction treatment, and addiction recovery with a particular focus on opioid addiction as a treatable medical condition (rather than a moral failing) and a threat to public health requiring the full mobilization of national, state, and local resources. This campaign will include a national panel of addiction medicine specialists whose role will be to educate the public and challenge any media-promulgated myths and misconceptions about opioid addiction, its treatment, and the long-term recovery process.

I will assure the national availability of naloxone overdose prevention kits to opioid users, their family members, and to police and other emergency first responders. That availability will be accompanied by an opioid overdose prevention campaign led by our Addiction Technology Transfer Centers and related resources and will include public education on the risks of mixing opioids with alcohol and other psychoactive drugs. Our first priorities must be to reduce the opioid overdose death rate and to assure that persons suffering from opioid addiction remain alive until community recovery support resources can help them achieve drug-free, productive, and meaningful lives. The more than 23,000 opioid overdose deaths per year in the U.S. is a national tragedy that must be ended.

I will help promote programs assuring that every emergency medical response to an opioid overdose is quickly followed by contact by an addiction treatment and recovery support specialist. Each of these medical emergencies is a window of opportunity for recovery initiation that must be capitalized upon.

I will support the local distribution of sterile needles and syringes to confirmed IV drug users to reduce their infectious disease risks and the risks of further transmission of such diseases to other opioid users, family members, and other members of the community. The goals of such support will also include reducing the burden such individuals will bring into a recovery process, to reduce the larger threat to public health of the community, and to provide a point of initial linkage to addiction treatment and recovery support resources.

I will support assertive outreach programs aimed at identifying and engaging opioid users at the earliest stages of drug dependence. At present, years or decades pass between the age of onset of opioid use and initial help-seeking. Such delays allow these problems to become severe, complex, and chronic, elevating the burden on family and community and compromising recovery outcomes. This pattern must be changed.

I will support a full range of medication-assisted and psychosocial treatment options without arbitrary time limits on treatment duration. I will support resources to elevate the quality and accountability of these programs, including integrating a broad range of psychosocial recovery support services with the pharmacotherapy of opioid addiction. The historical isolation and animosity between medication providers and those providing only psychosocial recovery support services must end. Creatively combining and sequencing medication, psychosocial treatment, and peer-based recovery support services may enhance recovery outcomes for opioid addiction in the same way combined interventions fundamentally altered the course of AIDS. I will support a full range of such integrated services for persons addicted to opioids who enter our drug courts, probation and parole services, and our correctional institutions. I will support research to assure that existing treatment models based on a century of treating heroin addiction are effective in treating a more demographically diverse generation of people addicted to prescription painkillers and anesthetic opioids.

I will push regulations requiring addiction treatment programs to measure and publicly report their long-term recovery outcome rates and require all treatment programs to review clinical and cost alternatives with each person/family seeking help. These regulations will also require dissemination of a research-based information brochure prepared by the National Institute on Drug Abuse that would identify effective and discredited treatments for opioid addiction. The purpose of such regulations would be to maximize personal choice and affordability in the selection of addiction treatment and diminish exploitive profiteering within this sector of health care.

I will challenge all programs within the addiction treatment industry to develop more effective methods of patient retention. The current rate of less than 50% completion nationally is completely unacceptable. It is time we made treatment reimbursement contingent upon provision of an adequate if not optimal dose/duration of treatment and recovery support services.

I will promote the expectation that all persons/families leaving addiction treatment will be provided ongoing recovery checkups and support for at least five years. Such long-term personal and family support must become standard care in treating the most severe and complex addictions as it is in the management of other chronic health conditions.

I will call for the expansion of training programs for primary care physicians to aid them in identifying opioid-using patients in need of opioid addiction treatment services as well as to increase their skills in providing post-treatment recovery checkups and support. Primary care physicians, psychiatrists, and their service staff must be fully engaged in supporting long-term recovery from opioid addiction and managing the medical and psychiatric conditions that frequently accompany opioid addiction.

I will support funding of local peer-based recovery support programs—recovery community centers, recovery residences, high school and collegiate recovery programs, recovery-focused employment and training programs, and support services delivered through recovery ministries. Such programs provide assertive linkage to Narcotics Anonymous and other secular, spiritual, and religious recovery support groups and help people in recovery develop a drug-free lifestyle within their natural environments. We must provide the physical, psychological, and cultural space within our local communities in which personal and family recovery can flourish.

I will support funding for local programs whose aim is to mobilize the growing legions of individuals and families who are recovering from opioid addiction as a volunteer force to help those currently experiencing addiction. This Volunteers in Recovery program will increase the visibility of local recovery role models and provide needed resources directly to local individuals and families and will provide added resources to reach people entering our emergency rooms, health clinics, service agencies, and jails. The goal of this effort will be to make addiction recovery contagious within local communities and to assure the availability of cost-effective measures of long-term addiction recovery support for affected individuals and their families.

There is much else to be done at the larger policy level, but I believe these twelve strategies will bring relief to affected individuals and families. These are the strategies I will pursue as your President.

I encourage recovery advocates across the country to make the town meetings and other campaign venues and to ask each presidential candidate the “What will you do?” question and compare their respective responses to these twelve points.